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Home E-Weekly May 8, 2018

Are Older Surgeons Safer Surgeons?

Published: May 8, 2018

Surgeon SHADES OF GRAY Experienced surgeons have what it takes to achieve better outcomes.

Wine, antiques, relationships and retirement funds get better with age. It might be time to add surgeons to the list, according to new research published in the British Medical Journal, which says older physicians have the skills and experience necessary to perform safer surgery.

Researchers who reviewed the outcomes of 892,187 patients operated on by 45,826 surgeons found the risk of dying within 30 days of surgery decreased when older surgeons operated: the mortality rate was 6.6% for surgeons younger than 40; 6.5% for surgeons in their 40s; 6.4% for surgeons in their 50s and 6.3% for surgeons 60 and older. There was no significant difference in mortality rates between male and female surgeons, although female surgeons in their 50s had the lowest mortality rates among the surgeons included in the study.

The link between mortality rates and a surgeon's age isn't causal and the exact reasons for the association are unknown, according to the study's authors. They did, however, offer potential explanations. First, surgeons could develop skills and knowledge over time that lead to better surgical outcomes. Second, recent restrictions on the number of hours surgical residents are allowed to work might impact the quality of their skills during the early part of their careers. Finally, older surgeons who continue to perform surgery late into their careers might be the highest skilled among their colleagues.

Despite the study's findings, Natalie Coburn, MD, cautions that it's extremely difficult to determine the quality of care surgeons provide. In an accompanying editorial, the associate professor of surgery at Sunnybrook Health Sciences Center in Toronto, Canada, says surgeons who specialize in a specific type of surgery might achieve better outcomes than general surgeons who perform several different types of procedures. Dr. Coburn also says it's challenging to determine the true complexity of procedures that are performed.

"Sometimes surgeons who appear to have the worst outcomes are actually the best surgeons, they're just taking on the hardest cases," she says.

Still, the study's authors say increasing the training, education and supervision of younger surgeons might improve the outcomes of the surgeries they perform.

Daniel Cook

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